Provider Demographics
NPI:1407372063
Name:CONRAD, COLLEEN LYNNE (CRNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:LYNNE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BAINBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-1769
Mailing Address - Country:US
Mailing Address - Phone:610-334-5614
Mailing Address - Fax:
Practice Address - Street 1:420 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-2143
Practice Address - Country:US
Practice Address - Phone:484-628-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017801363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health